Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Obstetrics and Gynecology, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi, Taiwan.
Int J Gynaecol Obstet. 2024 Jun;165(3):1244-1256. doi: 10.1002/ijgo.15362. Epub 2024 Jan 29.
Traditionally, the prognosis of patients with FIGO stage I endometrial cancer is determined by clinicopathological risk factors. In this study, we assessed the potential contribution of pretreatment carcinoembryonic antigen (CEA) and carbohydrate antigen-125 (CA-125) levels to estimating the prognosis of these patients and aimed to develop and validate a prognostic nomogram.
This retrospective study included patients with FIGO stage I endometrial cancer who underwent treatment between January 2009 and December 2021 in the four institutes of Chang Gung Memorial Hospital. To identify optimal cutoff values of CEA and CA-125 for predicting survival, receiver operating characteristic (ROC) curves were generated, the Kaplan-Meier method was used to estimate survival, and a Cox regression model was used to analyze the independent prognostic factors. Finally, a nomogram and calibration curve were constructed to predict patient survival probability.
Of the 1559 patients evaluated, the optimal cutoff values of CEA and CA-125 were 1.44 ng/mL (area under the ROC curve [AUC] 0.601) and 39.77 U/mL (AUC 0.503), respectively. Multivariate Cox regression analysis showed that pretreatment CEA (hazard ratio [HR] 2.11, 95% confidence interval [95% CI] 1.35-3.28), CA-125 (HR 2.07, 95% CI 1.31-3.27), age >70 years (HR 12.54, 95% CI 5.05-31.11), myometrial invasion >50% (HR 1.69, 95% CI 1.03-2.73), non-endometrioid histology (HR 1.83, 95% CI 1.14-2.95), high-grade tumor (HR 2.41, 95% CI 1.46-3.97), and lymphovascular space invasion (HR 2.32, 95% CI 1.26-4.25) were significant variables associated with overall survival. These factors were used to construct the nomogram model, which showed good concordance and accuracy.
Integration of pretreatment CEA and CA-125 in a prognostic nomogram is feasible. Our prediction model has the potential to assist clinicians in guiding appropriate clinical practice.
传统上，FIGO Ⅰ期子宫内膜癌患者的预后由临床病理危险因素决定。本研究旨在评估治疗前癌胚抗原（CEA）和糖链抗原 125（CA-125）水平对这些患者预后的潜在贡献，并旨在开发和验证一种预后列线图。
本回顾性研究纳入了 2009 年 1 月至 2021 年 12 月在长庚纪念医院四个院区接受治疗的 FIGO Ⅰ期子宫内膜癌患者。为了确定 CEA 和 CA-125 预测生存的最佳截断值，生成了受试者工作特征（ROC）曲线，采用 Kaplan-Meier 法估计生存情况，采用 Cox 回归模型分析独立预后因素。最后，构建列线图和校准曲线来预测患者的生存概率。
在评估的 1559 例患者中，CEA 和 CA-125 的最佳截断值分别为 1.44ng/ml（ROC 曲线下面积[AUC]0.601）和 39.77U/ml（AUC 0.503）。多因素 Cox 回归分析显示，治疗前 CEA（风险比[HR]2.11，95%置信区间[95%CI]1.35-3.28）、CA-125（HR 2.07，95%CI 1.31-3.27）、年龄>70 岁（HR 12.54，95%CI 5.05-31.11）、肌层浸润>50%（HR 1.69，95%CI 1.03-2.73）、非子宫内膜样组织学（HR 1.83，95%CI 1.14-2.95）、高级别肿瘤（HR 2.41，95%CI 1.46-3.97）和脉管侵犯（HR 2.32，95%CI 1.26-4.25）是与总生存相关的显著变量。这些因素被用于构建列线图模型，该模型显示出良好的一致性和准确性。
在预后列线图中整合治疗前 CEA 和 CA-125 是可行的。我们的预测模型有可能帮助临床医生指导适当的临床实践。
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